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Parent Information
Registration for Summer 2021
*
Indicates required field
Parents Name:
*
Parents Name (2):
*
Address
*
Parents Cell
*
Parents Cell (2)
*
Parents Email
*
Parents Email (2)
*
Swimmer's Name
*
First
Last
Gender
*
Male
Female
Swimmer's DOB
*
Age 6/1/21
*
Swimmer's Name
*
First
Last
Gender
*
Male
Female
Swimmer's DOB
*
Age 6/1/21
*
Swimmer's Name
*
First
Last
Gender
*
Male
Female
Swimmer's DOB
*
Age 6/1/21
*
Medical Release Information:
Primary Medical Insurance Name:
*
Policy Number:
*
Preferred Hospital:
*
Known Allergies or Other Pertinent Medical Information:
*
By submitting this form, I give my permission for my child to participate in the Trojan Aquatic Club. I will not hold the aquatic club, York Suburban School District or the coaching staff responsible for any injury while participating in the program. I also give permission for my child to be treated by emergency personnel in the event of an injury if I am not present.
Submit
Swimmer Registration
$225.00
Please add each swimmer as an item to your cart.
Add to Cart